Sleep Apnea Relief — Without the Dreaded Mask

If you’re one of the estimated 18 million Americans with obstructive sleep apnea, it’s likely you’ve been prescribed continuous positive airway pressure, better known as CPAP.

CPAP machines have been the standard of care for sleep apnea for 30 years. When used consistently, they drastically reduce nighttime apnea episodes (breathing stoppages) and associated risks such as high blood pressure, diabetes, heart attacks, strokes, and premature death.

“CPAP is the tried-and-true therapy,” says Robert Basner, M.D., of the Columbia University Medical Center in New York and a fellow of the American Academy of Sleep Medicine.

That said, Dr. Basner acknowledges that many patients hate CPAP.

Studies show that between 30 and 50 percent of patients either can’t or won’t use CPAP consistently. Many patients complain that the machine is noisy and that the tight-fitting mask makes them feel like Darth Vader. “There are people who are claustrophobic,” Dr. Baser tells Newsmax Health.

Other patients complain that CPAP causes congested sinuses and a dry throat.

Untreated sleep apnea is associated with a shortened life expectancy of 10 to 15 years. So this is no trivial matter.

Now, for the first time, there are alternatives to CPAP:

Oral pressure therapy (OPT) uses a mouthpiece to create suction that gently draws the soft palate forward, stabilizes the tongue, and opens the airway. California-based Apni-Cure Inc. makes an OPT machine called Winx, which gained FDA approval in 2012. The Winx machine costs about $700, which is similar to the cost of a CPAP machine, but so far it’s rarely covered by insurance.

According to the manufacturer, Winx works well for about half of sleep apnea patients, allows for sleeping in any position, and causes minimal disruptions to bed partners.

Hypoglossal nerve stimulation (HNT) uses a pacemaker-like device implanted in the chest to stimulate the nerve controlling the tongue muscles and open the airway.Minnesota-based Inspire Medical Systems makes an HNT device that is approved in Europe but not yet in the US, although it is available in trial. Tests show Inspire’s device is most effective for non-morbidly obese patients who suffer from a certain type of soft-palate collapse.

Expiratory positive airway pressure (EPAP) is a decidedly low-tech solution that consists of two Band Aid-like strips placed inside each nostril. Tiny valves open when patients breathe in and close when they breathe out, creating pressure that keeps the airway open. Theravent Inc. makes EPAP nasal strips it calls Provent Sleep Apnea Therapy. A one-month supply (a new pair must be applied each night) costs about $65. The strips usually aren’t covered by insurance and are ineffective for patients with sinus congestion.

There also is an older therapy called a mandibular advancement device (MAD) that works for some patients. Most MAD devices are made of hard plastic that covers the upper and lower teeth, and are fitted and sold by a dentist or orthodontist. They help open the airway by repositioning the jaw and bringing forward the tongue and soft palate.

“The mandibular advancement device has been studied a lot and is accepted by most experts and expert panels as a good alternative to CPAP,” Dr. Basner says. “In some cases, it works just as well.”

Dr. Basner says EPAP is the best-studied of the emerging therapies. “This is the least invasive of all the new therapies because it doesn’t involve having any suction on you, having anything implanted, or stimulating a nerve,” he says.

If you have sleep apnea and are overweight or obese, experts agree that the most important treatment is weight loss.

“Generally, there’s a linear response in terms of how many times you obstruct during the night and how many pounds you lose,” says Dr. Basner.

© 2014 NewsmaxHealth. All rights reserved.

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